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Individual

DR. PRICE P OMONDI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
1800 E LAKE SHORE DR, DECATUR, IL 62521-3810
(217) 464-2400
Mailing address
1001 HOLLOW VALLEY CT, CASEYVILLE, IL 62232-2838
(217) 403-1634

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-100726
IL
207Q00000X
Family Medicine Physician
036-100726
IL
208D00000X
General Practice Physician
036-100726
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
036100726
BLUE SHIELD
IL
05
036100726-1
IL
05
036100726-2
IL
05
036100726-3
IL
05
036100726-5
IL
05
1477504488
MO
05
200233440
IN
05
7100112980
KY
Enumeration date
05/15/2006
Last updated
11/08/2016
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